Ministry of Commerce And Supplies - Enhanced Integrated ...

N T I S2010Current Export Destinations: Most of the trade in health services occurs with India, and as both export andimports. In fact, all foreign patients in several healthcare institutions identified in the SAWTEE study (2008)were from India. According to industry sources that ITC spoke to, there are occasionally patients seekingtreatment in gynaecology, obstetrics and eye health services from other countries, including Tibet (China),Afghanistan, the Maldives, Germany, and NRN. The other major part is treatment of tourists, mainly fromdeveloped countries (EU, USA, Japan).Trade Balance: If one includes Nepalese medical workers abroad, then Nepal is probably a net exporter ofmedical services. No reliable data exist on the value of ‘mode 2’ imports from India. Nepal is also importinghealth services through ‘mode 3’. Indian medical schools and teaching hospitals affiliated to them areproviding medical services. Staff consist of both Nepalese and Indian doctors and nurses, but practically allpatients are Nepalese.Export Prospect: We rate the prospect for health services export as rather poor. Nepal does not have adeveloped healthcare sector that can provide services according to international standards, except may bein a few institutions. The existing trade is mainly local trade across the border, where Indians living relativelyclose to the border and often with personal links to Nepal seek treatment in Nepalese health institutions.Other foreigners receiving treatment in Nepal are usually tourists or expatriates who do not come to Nepal formedical purposes. Ayurvedic medicine could be a niche in which Nepal can become more successful. But theavailable information is too scarce to make any definite judgment on the export potential. A more detailedstudy by health sector exports, possibly along Lautier’s 2008 study of Tunisia, would have to be undertakento properly assess the potential. Whether such exports are desirable is another question that needs to becarefully evaluated (see below).Index 2: World Market ConditionsGlobal Trade in Health Services: Health services, like most other services, are still mainly ‘produced’ and‘consumed’ locally. But there has been a strong upward trend in international trade in healthcare. Somecountries report these trade flows in their BoP statistics, but unfortunately some of the new emergingexporters of healthcare services, including Thailand, Singapore, India, and Malaysia, do not. Therefore, usingBoP statistics would give us a fairly incomplete picture of the global market. Lautier (2008), in a paper thatassesses the Tunisian potential for health exports, provides an overview of the global market by combiningofficial statistics and estimates, resulting in an estimated size of the global trade of US$11.8 billion for 2003and annual growth rate of 15 per cent. If we assume a 10 per cent annual growth rate for the following years,then the 2008 size of the global market would have reached US$19 billion. 113The US has an estimated market share of 27 per cent, but some developing countries are emerging as majorplayers in global health trade. Data from Thailand show that 1 million foreign patients were treated in 2004,resulting in export revenue of US$500 million. India received 150,000 medical tourists in 2005 (WHO, 2008),including from developed countries such as the USA and the UK, apart from countries around the region.Index 3: Domestic Supply ConditionsMedical Services in Nepal: Health services in Nepal are being provided by four sectors, namely the government,community (called health cooperatives), NGOs, and private sector. Export of health services is being carriedout by NGOs (i.e. Tilganga Eye Hospital) and private health sectors (hospitals and nursing homes). Ayurvedic113Recorded trade flows based on BoP statistics have grown by 10 per cent annually between 2003 and 2007 (Source: TradeMap, based on IMFdata).106NEPAL TRADE INTEGRATION STRATEGY 2010BACKGROUND REPORT